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1.
目的 探讨神经外科手术中不同浓度异氟醚吸入麻醉期间脑电图(EEG)、颅内压(ICP)及血液动力学的变化。方法 30例鞍区肿瘤择期手术病人,ASAⅠ~Ⅱ级,以芬太尼、异丙酚、维库溴铵诱导插管后随机分三组,分别以0.5、1.0、1.5MAC异氟醚维持麻醉。观察入安静平卧时、吸入氟醚浓度达指定MAC时、切皮、锯硬膜时平均动脉压(MAP)、心率(HR)、颅内压(ICP)、脑电图95%边缘频率(SEF)及双  相似文献   

2.
相同MAC浓度的安氟醚和异氟醚对脑电图功率谱的影响   总被引:4,自引:0,他引:4  
24例 20~50岁、ASAⅠ级、行择期外科手术的患者,随机分成两组:安氟醚组和异氟醚组。不用术前药,麻醉诱导以静脉硫喷妥钠5mg/kg、阿曲库胺0.6~0.7mg/kg。单纯吸入安氟醚或异氟醚维持全麻。气管插管后控制呼吸,维持呼气末二氧化碳分压(PETCO2)4.27。4.93hpa。以TOF监测肌松,间断给予阿曲库胺 10~15mg,维持T4/T1<25%。采用 FP1-A1、FP2-A2双导联监护脑电,验证呼气末麻醉药浓度在 0. 5、0.8、1. 0、1. 3和 1.5 MAC时的脑电功率谱、95%边缘频率(SEF)和中心频率(MPF)改变。结果发现,随MAC增加脑电功率谱表现出波增加,α和β波减少,而SEF、MPF值随MAC增加而减少的改变呈负性线性关系,r=-0.95。提示脑电功率谱、SEF和MPF在评价全麻深度上有一定意义。  相似文献   

3.
地氟醚对交感兴奋作用的临床研究   总被引:4,自引:0,他引:4  
目的 探讨地氟醚的交感兴奋作用及其机理。方法 择期手术病人30例,ASAⅠ~Ⅱ级,随机分为地氟醚(15例)、异氟醚(15例)两组。不用术前药。气管插管后观察不同地氟醚和异氟醚水平(0.5MAC、1.0MAC和1.5MAC)对平均动脉压(MAP)和心率(HR)、心率变异性(HRV)和用改良荧光法测定血浆中肾上腺素(E)、去甲肾上腺素(NE)浓度的影响。结果 二组MAP、HR、E和NE在麻醉前、0.5  相似文献   

4.
地氟醚用于低流量吸入麻醉的可行性   总被引:8,自引:0,他引:8  
目的 探讨溶解度较低的地氟醚在低流量麻醉中的临床应用价值。方法 40例择期手术的胸腹部肿瘤病人,ASAI~Ⅱ级,分为A,B,C,D组,A,B组氧流量分别为2L/min和0.5/min吸入6%的地氟醚(1MAC)观察其肺泡浓度升高速率及差别。C,D组分别吸入氧流量为0.5/min1MAC异氟醚和安氟醚作为对照组,结果 A组FA/FI和FA/FD达1/2时间分别为1分钟和4分钟;在12分钟时FA/FI  相似文献   

5.
目的 观察地氟醚对老年病人血液动力学的影响。方法 择期老年手术病人30例,ASAⅠ~Ⅱ级。硫喷妥钠、琥珀胆碱、芬太尼诱导插管后,经口插入经食管多普勒心输出理测定仪。观察不同MAC地氟醚对老年病人的CO、PV、FTC、CVP、CI、MAP、SVR的影响。结果 与吸入前相比,MAP、SVR在1.0MAC、1.5MAC及2.0MAC时显著下降(P〈0.05或0.01),HR、FTC在0.5MAC时无明显  相似文献   

6.
脑电功率谱分析用于监测手术切皮时的麻醉深度   总被引:2,自引:0,他引:2  
目的:评价脑电功率谱分析技术反映麻醉深度的准确性。方法:65例ASAⅠ级腹部手术病人,快速静脉诱导气管插管后,机械通气,维持PETCO2在正常范围内。麻醉:O2-N2O(1∶2)-七氟醚吸入,切皮前不追加长效肌松药。随机分为三组:Ⅰ组n=25、Ⅱ组n=20、Ⅲ组n=20。七氟醚呼气末浓度分别为1.0%、1.5%、2.0%,至少维持15分钟。应用数量化脑电图监测仪监测手术切皮前、后3分钟脑电图的改变,同时监测MAP、HR的改变,切皮后四肢肌肉活动、面部表情变化、呛咳或切皮前不能耐受气管插管刺激者定为切皮反应阳性。结果:切皮前三组病人的EEG随七氟醚呼气末浓度增加,波谱边缘频率(SEF)、中频率(MF)、双谱指数(BIS)明显降低(P<0.01),δ波比率(δR)明显升高(P<0.01),MAP仅Ⅰ组和Ⅲ组之间有差异(P<0.05),HR三组之间无统计学差异。切皮反应者的SEF、MF、BIS明显高于无反应者,δR明显低于无反应者(P<0.01)。反应者切皮前、后的MAP和HR变化差明显大于无反应者(P<0.01)。结论:EEG数量化指标SEF和BIS能较准确地反映切皮前七氟醚麻醉深度。  相似文献   

7.
目的 研究静吸复合麻醉中不同小剂量芬太尼对脑电边缘频率(SEF)和双小的指数(BIS的影响。方法 随机将ASAⅠ~Ⅱ级病人30例分为Ⅰ、Ⅱ、Ⅲ组地全麻诱导吸入安氟醚达0.8MAC后三组分别静注芬太尼3μg.kg^0-1、5μg.kg^-1,于给药后6min记录每组病人的MAP、HR、SEF及BIS。结果 三组 内、组间MAP、HR相比均无显著差异(P〈0.05),BIS无显著性差异(P〉0.05)  相似文献   

8.
安氟醚,七氟醚和异丙酚对胸肺静态顺应性的影响   总被引:1,自引:0,他引:1  
24例ASAⅠ ̄Ⅱ级在全麻下行乳癌根治术的患,分为三组:安氟醚组(E)、七氟醚组(S)和异丙酚组(Pro)。E、S组分别以1.0MAC的安氟醚和七氟醚维持麻醉。Pro组静点异丙酚4 ̄6mg·kg^-1·h^-1维持麻醉。采用吸气末气道阻断法测定胸肺静顺应性(Crs)。用药30分钟后Crs明显降低(P〈0.01);Pro组的Crs下降上于E和S组(P〈0.05)。表明:麻醉药是影响Crs的重要因素  相似文献   

9.
地氟醚对全麻病人血液动力学的影响   总被引:6,自引:1,他引:5  
目的 观察地氟醚对全麻病人血液动力学的影响。方法 择期手术病人30例,ASAⅠ级者15例(Ⅰ组),高血压者15例(Ⅱ组)。芬太尼、依托咪酯、维库溴铵诱导后,插入多普勒气管导管,观察不同MAC地氟醚对两组MAP、SVR、HR、CVP、CI的影响。结果 两组MAP、SVR,随地氟醚MAC的升高呈剂量依赖性下降,在2.0MAC时Ⅱ组比Ⅰ组下降显著。HR、CVP在1.0MAC时无变化;在1.5MAC及2.  相似文献   

10.
目的:探讨数量化脑电图与七氟醚麻醉深度的关系。方法:62例腹部手术病人,常规麻醉诱导、气管内插管。机械通气,潘库溴铵或阿曲库铵维持肌松。手术探查毕,调整每个病人的七氟醚呼气末浓度依次达2%→1.5%→1%,每种浓度维持至少15分钟,记录3分钟数量化EEG及MAP、HR变化。结果:随七氟醚呼气末浓度降低,原始脑电波逐渐由低频高振幅波转变为高频低振幅波;SEF和MF趋势曲线明显右移;SEF、MF、BIS、δR明显差异(P<0.01)。血流动力学的变化仅在七氟醚呼气末浓度1%与2%时有明显差异(P<0.01)。结论:数量化脑电图能监测不同七氟醚麻醉深度时大脑皮层电活动变化,而MAP和HR只能区别极深和极浅的麻醉状态。  相似文献   

11.
Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI2) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI2), TXB2 (stabile metabolite of thromboxane A2) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI2 release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB2 (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI2 release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A2, presumably contributing to hemodynamic stability within 30 min after MT.  相似文献   

12.
Don Dame 《Artificial organs》1996,20(5):613-617
Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.  相似文献   

13.
Background: Halothane inhibits in vitro and in vivo activity of cytochrome P-450 (CYP) 2E1. There are several fluorinated volatile anaesthetics besides halothane, and most of them are defluorinated by CYP2E1. It is unclear whether other fluorinated anaesthetics inhibit the in vivo activity of CYP2E1.
Methods: We compared the inhibitory effects of therapeutic concentrations of four inhalational anaesthetics, halothane, enflurane, isoflurane, and sevoflurane, on chlorzoxazone metabolism in rabbits receiving artificial ventilation.
Results: All four inhalational anaesthetics decreased arterial blood pressure and increased plasma chlorzoxazone concentration. However, no significant differences in the plasma chlorzoxazone concentration were found between the four anaesthetics. The estimated chlorzoxazone clearance increased after beginning inhalation with all four agents, but no significant difference in clearance was noted between agents.
Conclusions: At therapeutic concentrations, the in vivo inhibitory effect on chlorzoxazone metabolism was similar for all four inhalational anaesthetics examined, even though their chemical characteristics and extent of hepatic metabolism differ considerably.  相似文献   

14.
Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.  相似文献   

15.
Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H2O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg−1 followed by 0.15 mg · kg−1 · h−1, n=8) or verapamil (0.1 mg · kg−1 followed by 0.3 mg · kg−1 · h−1, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.  相似文献   

16.
Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.  相似文献   

17.
Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.  相似文献   

18.
Background: It has been shown that the depressive effects of both propofol and midazolam on consciousness are synergistic with opioids, but the nature of their interactions on other physiological systems, e. g. respiration, has not been fully investigated. The present study examined the effect of propofol and midazolam alone and in combination with fentanyl on phrenic nerve activity (PNA) and whether such interactions are additive or synergistic. Methods: PNA was recorded in 27 anaesthetised and artificially ventilated rabbits. In three groups, propofol, fentanyl and midazolam were administered intravenously in incremental doses to construct dose-response curves for the depressant effects of each one on PNA. In another two groups, the effect of pretreatment with either fentanyl 1 μg · kg?1 i. v. or midazolam 0.05 mg · kg?1 i. v. on the effects of propofol and fentanyl respectively on PNA were studied. Results: Propofol and fentanyl caused a dose-dependent depression of PNA with complete abolition at the highest total doses of 16 mg · kg?1 i. v. and 32 μg · kg?1 i. v., respectively. In contrast, midazolam in incremental doses to a total of 0.8 mg · kg?1 reduced mean PNA by 63%, but approximately 12% of PNA remained at a total dose as high as 6.4 mg · kg?1. The mean ED50s, calculated from dose-response curves, were 5.4 mg · kg?1, 3.9 μg · kg?1 and 0.4 mg · kg?1 for propofol, fentanyl and midazolam, respectively. Initial doses of either fentanyl 1 μg · kg?1 i. v. or midazolam 0.05 mg · kg?1 i. v. acted synergistically with subsequent doses of either propofol or fentanyl to abolish PNA at total doses of 8 mg · kg?1 and 8 μg · kg?1, respectively. Conclusion: Fentanyl has a synergistic interaction with both propofol and midazolam on PNA and hence potentially on respiration.  相似文献   

19.
Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg?1 · min?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min?1 · m?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO2I) and oxygen consumption index (VO2I) were also significantly increased in the dopexamine group (DO2I: from 416±91 to 717±110 ml/m2 · m2; VO2I: from 98±25 to 157±22 ml/m2 · m2), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.  相似文献   

20.
A concept of balanced analgesia using nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol (acetaminophen), opioids, and corticosteroids can also be used in patients with pre-existing illnesses. NSAIDs are the most effective treatment for acute pain of moderate intensity in children; however, these drugs should be avoided in patients at increased risk for serious side effects, e.g. patients with renal impairment, bleeding tendency, or extreme prematurity. NSAIDs can be given with minimal risks to the younger child with mild to moderate asthma, and, in these patients, the use of steroids can be encouraged; in addition to their antiemetic and analgesic action, a beneficial effect on asthma symptoms can be expected. In the non-intubated child with cerebral trauma, exaggerated sedation caused by opioids and increased bleeding tendency caused by NSAIDs must be avoided. In neonates and small infants, the oral administration of sucrose or glucose is helpful to minimize pain reaction during short uncomfortable interventions.  相似文献   

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